Continuous local intra-arterial nimodipine administration in severe symptomatic vasospasm after subarachnoid hemorrhage

Neurosurgery. 2011 Jun;68(6):1541-7; discussion 1547. doi: 10.1227/NEU.0b013e31820edd46.

Abstract

Background: Cerebral vasospasm (CV) is a potentially disastrous consequence of subarachnoid hemorrhage despite medical treatment. Nimodipine is a potent drug for vessel relaxation, but side effects may preclude a sufficient dose.

Objective: To explore whether continuous local intra-arterial nimodipine administration (CLINA) can reverse vasospasm and prevent delayed ischemic neurological deficit.

Methods: Six consecutive subarachnoid hemorrhage patients (5 women; mean age, 47.2 years) with severe CV despite maximum medical therapy underwent CLINA within 2 hours after the onset of clinical symptoms. After anticoagulation, microcatheters were inserted distally in the concerning supra-aortic vessels. Glyceryl trinitrate injection (2 mg) was followed by CLINA (nimodipine 0.4 mg/h for 70-147 hours). Duration of CLINA was determined by neurological status, transcranial Doppler sonography, and partial tissue oxygen pressure values.

Results: In all patients, neurological deficits improved or partial tissue oxygen pressure values returned to normal and transcranial Doppler sonography confirmed a reduced blood flow velocity within 12 hours. Magnetic resonance imaging showed no ischemic lesion caused by CV. Neurological outcome was good (modified Rankin Scale score, 0-2) in 3 patients, whereas 1 patient had a moderate clinical outcome (modified Rankin Scale score, 3-4) and 2 patients had a poor outcome (modified Rankin Scale score, 5) because of the SAH.

Conclusion: Preliminary data show that CLINA is a straightforward, effective, and safe option for patients with severe CV refractory to medical therapy. Dilation of spastic arteries starts within a few hours and is lasting. Indication for CLINA is peripheral and diffuse CV at any location.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cerebral Angiography
  • Cerebrovascular Circulation / drug effects*
  • Female
  • Humans
  • Infusions, Intra-Arterial
  • Male
  • Middle Aged
  • Nimodipine / administration & dosage*
  • Retrospective Studies
  • Subarachnoid Hemorrhage / complications*
  • Vasodilator Agents / administration & dosage*
  • Vasospasm, Intracranial / drug therapy*
  • Vasospasm, Intracranial / etiology

Substances

  • Vasodilator Agents
  • Nimodipine